Perimembranous ventricular septal defect and Tricuspid Regurgitation: Does Closure Heal the Valve in pediatrics?

Background: Tricuspid regurgitation (TR) frequently occurs as a functional complication of perimembranous ventricular septal defect (pmVSD) in pediatric patients. Surgical closure may alleviate tricuspid regurgitation (TR); however, evidence regarding the impact of transcatheter closure on TR improvement is currently insufficient. Methods: A prospective observational analysis was conducted on 55 pediatric patients who underwent transcatheter closure at the National Heart Institute between September 2023 and March 2025 and had hemodynamically severe pmVSD with at least moderate TR. Under the guidance of fluoroscopic and echocardiographic monitoring, patients underwent transcatheter closure. TR severity, left ventricular end diastolic/systolic dimensions (LVEDD, LVESD), and ejection fraction (LVEF) were measured by transthoracic echocardiography at baseline and after one and six months. To conduct statistical analysis, SPSS version 26 was utilized. Results: Following the intervention, there were notable decreases in the severity of TR: the tricuspid regurgitation jet area decreased from 4.63 cm² to 1.16 cm². The mild, moderate, and severe TR subgroups all saw this improvement; after six months, mild TR dropped from 2.98 cm² to 0.72 cm², moderate TR from 6.6 cm² to 1.2 cm², and severe TR from 10.4 cm² to 4.2 cm² (all p<0.001). There were no reports of residual shunts. There were just two patients (3.6%) who had mild issues. Conclusion: While keeping a strong safety record, transcatheter pmVSD closure dramatically reduces functional TR in pediatric patients. Its use as a first-line therapy for some patients is supported by this data. However, larger studies are required to confirm long-term impacts.